| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
4,719 |
4,606 |
$1.09M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
195 |
192 |
$130K |
| D0340 |
|
1,190 |
1,188 |
$61K |
| D0330 |
Panoramic radiographic image |
1,203 |
1,203 |
$42K |
| D8680 |
|
226 |
225 |
$42K |
| D8660 |
|
1,203 |
1,202 |
$34K |
| D0350 |
|
1,668 |
1,662 |
$20K |
| D0470 |
|
208 |
204 |
$7K |
| D1110 |
Prophylaxis - adult |
72 |
72 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
13 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
25 |
25 |
$665.95 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$330.60 |